Abstract
Strong and consistent evidence of higher incidence of psychosis, crisis pathways to care and poor outcomes following first episode of psychosis (FEP) in ethnic minority populations have been reported particularly among Black African and Caribbean populations in the UK. Further, there is ongoing debate about the role of early intervention services which have shown promising effects on reducing treatment delays and a range of outcomes following FEP. This study aimed to estimate ethnic differences in the incidence of psychosis, pathways to care and two-year service use outcomes in three ethnic groups (namely, White British, Black African and Black Caribbean). An investigation of pathways to care and clinical outcomes comparing early intervention service (EIS) and non-EIS users was also conducted.An administrative incidence study design with a follow up cohort study of outcomes of psychoses was employed to investigate the aims of this study. First episode psychosis cases were identified and their data were drawn from the South London and Maudsley NHS Foundation (SLaM) Biomedical Research Centre case register. Pathways to care, sociodemographic and clinical information were collected using the Personal and Psychiatric History Schedule (PPHS, WHO, 1996) the Medical Research Council Socio-demographic schedule (Mallett et al., 1997) and the Life Chart schedule (WHO, 1992) respectively for the purpose of case note data extraction. Data on 558 FEP patients were analysed using standardised incidence rate (SIR) / Poisson regression, logistic regression and negative binomial regression.
Higher incidence rates were found among Black African (adj. IRR =3.59; 95% CI 2.8 – 4.55) and Black Caribbean (adj. IRR = 2.81; 95% CI 2.15 – 3.68) ethnic groups compared with the White British group.
At first contact for psychosis, Black African (adj. OR = 3.23; 95% CI 1.57–6.63) patients were more likely to be compulsorily admitted, but there were no differences between Black Caribbean (adj. OR = 1.78; 95% CI 0.75–4.24) and White British patients. Comparison of pathways to care between the AESOP study and this study data showed that there were no ethnic differences in GP or criminal justice agency referral in this study compared with the AESOP study. However, there was evidence that Black African (adj. OR = 7.34; 95% CI1.15–46.74) and Black Caribbean (adj. OR = 48.89; 95% CI3.49–684.71) patients were more likely to be referred by the accident and emergency department.
At two-year follow-up Black African patients experienced worse service use outcomes, as well as higher rates of compulsory admissions (adj. IRR =3.01; 95% CI1.33–6.80) and hospital admissions (adj. IRR = 1.98; 95% CI1.12–3.48). Ethnic differences were not evident between Black Caribbean and White British patients on compulsory admission or hospital admission outcomes at follow-up. Further, compared with patients who accessed early intervention service, patients in the non-EIS group were more likely to be hospitalised (adj. IRR = 3.30; 95% CI 1.98–5.49), and compulsorily admitted (adj. IRR = 2.22; 95% CI1.18–4.18).
This study provides a novel insight into the associations between ethnicity and incidence of psychosis, pathways to care and outcomes of two-year follow-up service use, and hints at a possibility that the service engagement disparities between Black Caribbean and White British patients may be diminishing.
| Date of Award | 1 Jun 2018 |
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| Original language | English |
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| Supervisor | Craig Morgan (Supervisor), Tom Craig (Supervisor), Jayati Das-Munshi (Supervisor) & Dinesh Bhugra (Supervisor) |